Retractor Tool For Minimally Invasive Hip Replacement Surgery

ABSTRACT

A retractor system, kit and method of use includes a plurality of retractors for use in retracting a wound during a minimally-invasive hip replacement surgery to define an access space to a surgical site is discussed. Each of the retractors comprises a handle portion configured to be held by a user, a curved bend portion distal of the handle portion, and a wound contact portion attached to the curved bend portion. The wound contact portion is configured to contact tissue of the wound when at least a portion of the retractor is inserted through a skin incision that defines the wound. Each retractor also has a distal portion disposed distally of the wound contact portion, wherein the wound contact portion has a generally curved cross-sectional profile perpendicular to its length that is configured to prevent necrosis of the tissue during retraction. In addition, the cross-sectional profile provides an improved line of sight during the surgical procedure. Furthermore, the cross-sectional profile prevents the jamming of a cutting device, such as a reamer inserted through the incision, while the retractors retract the wound.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority from U.S. Provisional PatentApplication Ser. Nos. 61/368,754, filed Jul. 29, 2010; 61/368,761, filedJul. 29, 2010; and 61/368,768 filed Jul. 29, 2010.

FIELD OF THE INVENTION

The present invention is directed to minimally invasive surgery, andmore particularly to retractor tools for use in minimally invasive hipreplacement surgery.

PRIOR ART

Approximately 200,000 hip replacements are performed each year in theUnited States and the number is expected to continue to grow as thepopulation continues to age. The usual reasons for hip replacement areosteoarthritis, rheumatoid arthritis and traumatic arthritis, all ofwhich can cause pain and stiffness that limit mobility and the abilityto perform daily living activities. Hip replacement surgery is usuallyperformed where other measures (e.g. physical therapy, medications, andwalking aids) are unable to overcome the chronic pain and disabilityassociated with these conditions.

Various techniques are used by orthopedic surgeons to perform hipreplacements. These include the following approaches: anterior,antero-lateral, lateral, postero-lateral and posterior. The posteriorand postero-lateral approaches account for approximately 60%-70% of hipreplacement surgeries.

Traditional hip replacement surgery involves an open surgical procedureand extensive surgical dissection. However, such procedures require alonger recovery period and rehabilitation time for the patient. Theaverage hospital stay for open hip replacement procedures is 4-5 days,followed in most cases by extensive rehabilitation.

More recently, there has been considerable interest and research done inMinimally Invasive Surgery (MIS), including the use of MIS procedures inconnection with hip replacement surgery. In comparison with thetraditional open surgical approach, MIS hip replacement surgeriesinvolve fewer traumas to the muscles surrounding the hip joint.Specifically, fewer muscles that help to stabilize the hip joint are cutin MIS hip replacement surgeries, reducing the risk of dislocation ofthe hip surgery and speeding recovery. Patients spend less time in thehospital and return to normal life activities more quickly.

MIS approaches use smaller surgical openings, which require specializedinstruments to perform hip replacement procedures. Some of theseinstruments are surgical retractors used to retract tissue. This allowsvisualization of the surgical site and insertion of surgical tools, suchas reamers, broaches and ultimately surgical implants. However, the useof conventional retractors in MIS hip surgery has often resulted innecrosis of the tissue that borders the incision and against which theretractors are pressed to maintain the access path to the surgical site.This necrosis can necessitate the surgical excision of such tissue.Additionally, conventional hip surgery retractors have a flat andgenerally rectangular cross-sectional profile. This frequently resultsin impingement on the rotating reamer as the latter is inserted throughthe incision to ream the acetabulum. Accordingly, there is a need for animproved retractor tool for use in MIS orthopedic procedures (e.g., hipreplacement surgery) that addresses some of the shortcomings in theexisting surgical retractors noted above.

SUMMARY OF THE INVENTION

In accordance with one embodiment, a retractor for use in minimallyinvasive hip replacement surgery is provided. The retractor comprises ahandle portion configured to be held by a user and a curved bend portiondistal to the handle portion. A wound contact portion is attached to thecurved bend portion, the wound contact portion configured to contacttissue of a wound when at least a portion of the retractor is insertedthrough a skin incision that defines the wound. In addition, a distalportion disposed distally of the wound contact portion, contacts thebony anatomy, particularly of the acetabulum and proximal femur. Thewound contact portion has a generally curved cross-sectional profileperpendicular to its length that is configured to prevent necrosis ofwound tissue during retraction of the wound with the retractor.

In accordance with another embodiment, a retractor with an alternatedesign for use in minimally invasive hip replacement surgery isprovided. This alternate retractor embodiment comprises a handleportion, configured to be held by a user that is centrally locatedbetween two wound contact portions. Two distal wound contact portionsextend distally from the centrally located handle portion. The woundcontact portions are configured to contact tissue of a wound when atleast a portion of the retractor is inserted through a skin incisionthat defines the wound.

Both retractor embodiments comprise a shaft that connects the handleportion to the wound contact portion and distal portion of theretractor. In addition to reducing tissue necrosis, the curvedcross-sectional profile of the shaft provides an improved line of siteduring surgical procedures. The curved cross-sectional profile of theshaft minimizes visual obstruction thereby resulting in improved controlof the tool during the surgical procedure.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic drawing illustrating an anatomical region of thehip area.

FIG. 2 is a schematic drawing of an area of the pelvic region of ahuman.

FIG. 3 is a schematic drawing of a pelvic girdle of a human.

FIG. 4 is a perspective view illustrating an embodiment of a piriformisretractor.

FIG. 4A is a cross-sectional view of a shaft of the piriformis retractorembodiment shown in FIG. 4.

FIG. 5 shows a top view of the piriformis retractor embodiment shown inFIG. 4.

FIG. 6 illustrates a side view of the piriformis retractor embodimentshown in FIG. 4.

FIG. 7 is a perspective view of an embodiment of a posterior acetabularretractor.

FIG. 7A is a cross-sectional view of a shaft of the posterior acetabularretractor embodiment shown in FIG. 7.

FIG. 8 shows a top view of the posterior acetabular retractor embodimentshown in FIG. 7.

FIG. 9 shows a side view of the posterior acetabular retractorembodiment shown in FIG. 7.

FIG. 10 illustrates a perspective view of an embodiment of an anteriorretractor.

FIG. 10A shows a cross-sectional view of a shaft of the anteriorretractor embodiment shown in FIG. 10.

FIG. 10B shows a perspective view of an alternate embodiment of ananterior retractor.

FIG. 11 shows a top view of the anterior retractor embodiment.

FIG. 11A illustrates a top view of the alternate embodiment of theanterior retractor shown in FIG. 10A.

FIG. 12 shows a side view of the anterior retractor shown in FIG. 10.

FIG. 13 illustrates a perspective view of an embodiment of a femoralneck retractor.

FIG. 13A shows a cross-sectional view of a shaft of the femoral neckretractor embodiment shown in FIG. 13.

FIG. 14 illustrates a side view of the embodiment of the femoral neckretractor shown in FIG. 13.

FIG. 15 shows a top view of the femoral neck retractor shown in FIG. 13.

FIG. 16 illustrates a perspective view of an embodiment of a doubleended retractor.

FIG. 16A shows a cross-sectional view of a shaft of the double endedretractor embodiment shown in FIG. 16.

FIG. 17 shows a side view of the double ended retractor shown in FIG.16.

FIG. 18 shows a top view of the double ended retractor shown in FIG. 16.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Now turning to the figures, FIGS. 1-3 illustrate some features of themusculoskeletal anatomy, specifically the hip region 10 of a human.FIGS. 4-18 illustrate embodiments of orthopedic retractor tools of thepresent invention. As shown in FIGS. 1-3, there are several muscles thatact to stabilize the femoral head of a femur bone 12 in the acetabulum(FIG. 2). These muscles include the short external rotator muscles(i.e., the piriformis 14, the superior gemellus 16, the obturatorinternus 18, the inferior gemellus 20, the obturator externus (notshown) and the quadratus femoris 22). The gluteus maximus (not shown)extends over these short external rotator muscles. The femoral head 26is enclosed in a fibrous capsule 28, which attaches to the hip boneoutside the acetabular lip 30 and to the base of the neck of the femoralhead 26.

The MIS posterior hip replacement approach has traditionally involvedfirst a skin incision, followed by an incision in the fascia lata, andthen detachment of the short external rotator muscles of the hip 10.However, it has been found that through a modified MIS posterior hipreplacement approach only the piriformis muscle 14, and occasionally thesuperior gemellus 16, requires detachment. Through this modified MISapproach, the obturator internus 18, inferior gemellus 20, the obturatorexternus (not shown) and the quadratus femoris 22 are always leftintact.

In a preferred embodiment, the surgeon begins by making an incision 32in a posterior side of a patient's hip 10 (e.g., on the buttocks) on aside proximate the hip joint to be treated. The surgeon can thenseparate fibers in the gluteus maximus longitudinally (not cuttransversely) using a trans-gluteus maximus approach to access theexternal rotators of the hip 10 and then the hip capsule 28. The presentapproach does not involve an incision in the fascia lata, which isrequired in other posterior surgical approaches, as well as in theantero-lateral and lateral approaches to the hip 10. The surgeon canthen detach the pirifromis 14, and sometimes the superior gemellus 16,which, as discussed above, are the only short external rotator musclesthat are detached with this approach. This approach preserves theobturator internus 18, inferior gemellus 20, obturator externus (notshown) and quadratus femoris 22, which provides significant additionalstability to the hip 10, and contributes to a faster post operativerecovery.

Once access to the acetabulum 34 is achieved, the surgeon can advance acutting tool 36 such as a reamer, through the wound defined by theincision 32 to the surgical site proximate the acetabulum 34 and preparethe bone for implantation of a prosthetic cup (not shown). In anembodiment, the femoral head 26 is also removed and a prosthetic hipstem (not shown) is implanted into the femur 12, the prosthetic hip stemcomprises a modular femoral head that articulates with the acetabularcup prosthesis. Once the prosthesis is in place, the capsule 28 can beclosed, followed by closure of the incision 32.

FIGS. 4, 4A, 5 and 6 show a preferred embodiment of a retractor 100,namely, a piriformis retractor which is also generally referred to as aninferior acetabular retractor. The retractor 100 has a handle portion102, a bend portion 104, a wound contact portion 106 and a distalportion 108. As shown, the distal portion 108 can have a generallyrectangular cross-section. Although a rectangular cross-section ispreferred, the distal portion 108 may have a curved cross-section. In apreferred embodiment, a length 112 of the retractor 100 extends from aproximal end 110 to the wound contact portion 106. It is preferred thatthe length 112 ranges from about 200 mm to about 400 mm. Furthermore, ashaft 114 extends therebetween the wound contact portion 106 and thehandle portion 102.

The shaft 114 preferably has a curved cross-sectional profileperpendicular to its length, and more preferably a round cross-sectionalprofile as shown in FIG. 4A. In a preferred embodiment, the shaft 114has a thickness 116 that ranges from about 5 mm to about 10 mm indiameter. However, it is contemplated that the thickness 116 of theshaft 114 may be larger than 10 mm or smaller than 5 mm.

The bend portion 104 resides therebetween the handle portion 102 and thedistal portion 108 of the retractor 100 as shown in FIG. 5. The bendportion 104 has a bend angle 118 that generally measures about 90°. Thebend angle 118 is measured between horizontal axis A-A, co-axial to thehandle portion 102, and perpendicular axis B-B. Alternatively, bendportion 104 may have a bend angle 118 that ranges from about 70° toabout 130°.

The handle portion 102 resides at the proximal end 110 of the retractor100. In a preferred embodiment, the handle portion 102 has a rectangularcross-section with a generally planar top 120 and bottom surface 122.Alternatively, the handle portion 102 may be constructed with a round oroval cross-section. The handle 102 can have a thickness 124 that may belarger or smaller than the thickness 116 of the shaft 114. An opening126 may extend through the handle portion 102 from the top surface 120through the bottom surface 122.

The distal portion 108 of the retractor 100 preferably has a height 128ranging from about 50 mm to about 100 mm, a thickness 130 of about 3 mmand a maximum width 134 of about 12 mm. Furthermore, a height 132extends between the distal end 138 of the retractor 100 and a bottomsurface 122 of the handle portion. It is preferred that this height 132range from about 100 mm to about 200 mm.

In a preferred embodiment, the distal portion 108 has a generallyrectangular cross-section with a distal portion width 134 that may rangefrom about 2 mm to about 20 mm. In a preferred embodiment, the width 134of the distal portion 108 gradually decreases to a pointed end. Asillustrated, a prong 136 extends to the distal end 138 of the retractor100. The prong 136 preferably bends in an upwardly and outwardlydirection from perpendicular axis B-B as shown in FIGS. 4 and 6. In apreferred embodiment, prong 136 bends outwardly or inwardly about 1° toabout 15° from perpendicular axis B-B. However, it is contemplated thatthe retractor 100 may be constructed with other dimensions that arelarger or smaller than those given above.

FIGS. 7, 7A, 8 and 9 illustrate a preferred embodiment of a retractor200 generally referred to as a “posterior acetabular retractor”. Asillustrated, the retractor 200 generally comprises an “S” shaped curveportion 202 distal of its handle portion 204. The “S” shaped curveportion 202 comprises a first bend portion 206 and a second bend portion208. As illustrated, the retractor 200 further comprises a wound contactportion 210 and a distal portion 212. A shaft 214 extends distally fromthe handle portion 204 to a distal end 216 of the retractor 200.

In an embodiment, a length 218 of the retractor 200 extends from theproximal end 220 to the wound contact portion 210. In a preferredembodiment, the length 218 ranges from about 300 mm to about 400 mm. Athickness 222 of the shaft 214 has a diameter that ranges between about5 mm to about 10 mm.

Similar to retractor 100 as previously discussed, the handle portion 204of retractor 200 resides at the proximal end 220 of the retractor 200.Like retractor 100, the handle portion 204 has a generally rectangularcross-section with a generally planar top 224 and bottom surface 226.Alternatively, the handle portion 204 may be constructed with a round oroval cross-section. The handle portion 204 can have a handle thickness228 that may be larger or smaller than the thickness 222 of the shaft214. An opening 230 may extend through the handle portion 204 extendingfrom the top surface 224 through the bottom surface 226.

The first bend portion 206 has a first radius of curvature 232. Thefirst radius of curvature 232 is defined by the radius that residesalong a surface 234 of the first bend portion 206 that extends from ahorizontal axis C-C of the handle portion 204 to an apex point 236,positioned between the first and second bend portions 206, 208. Thefirst bend portion 206 generally has a curved cross sectional profileperpendicular to its length, and more preferably, a roundcross-sectional profile. It is preferred that the first radius ofcurvature 232 ranges from about 5 mm to about 25 mm.

The second bend portion 208 has a second radius of curvature 238. Thesecond radius of curvature 238 is defined by the curved radius thatresides along a surface 240 of the bend portion 208 from the apex point236 to the end of the distal portion 216. It is preferred that thesecond bend portion 208 has a second radius of curative 238 that rangesfrom about 2 mm to about 10 mm. The second bend portion 208 generallyhas a curved cross sectional profile perpendicular to its length, andmore preferably, a round cross-sectional profile. A prong 242 preferablyextends outwardly and upwardly from an edge 244 of the distal portion212. As illustrated in FIG. 7, the width 250 of the prong 242 graduallydecreases to a pointed end which corresponds to the distal end 216 ofthe retractor 200.

In a preferred embodiment, the distal portion 212 is of a generallyrectangular shape with a distal portion width 246, length 252 andthickness 254. In a preferred embodiment, the width 246 of the distalportion 212 ranges from about 10 mm to about 20 mm, the distal portionlength 252 ranges from about 15 mm to about 30 mm and the distal portionthickness 254 ranges from about 1 mm to about 5 mm. As shown in FIG. 7,the prong 242 extends distally from an edge 244 of the distal portion212. In a preferred embodiment, the prong 242 extends about 2 mm toabout 10 mm from the edge 244 of the distal portion 212. Furthermore,the prong 242 may extend upwardly or downwardly from the edge 244 of thedistal portion 212. Additionally, a height 248 between the distal end216 of the retractor 200 to the bottom surface 226 of the handle portion204 ranges from about 100 mm to about 200 mm.

Alternatively, retractor 200 may be designed without the second bendportion 208, comprising only the first bend portion 206. In thisalternative embodiment, the distal portion 212 extends downwardly fromhorizontal axis C-C such that the distal portion is generally aboutperpendicular to the horizontal axis C-C.

FIGS. 10, 10A, 10B, 11, 11A and 12 illustrate embodiments of a retractor300 generally referred to as an “anterior retractor”. As illustrated,retractor 300 has a generally curved shape with a distal portion 302that extends from a handle portion 304 at a proximal end 308. A woundcontact portion 310 extends therebetween.

In a preferred embodiment, the retractor 300 has a bend portion 312 thatis defined by a curved surface 314 (FIG. 12) that extends between thedistal portion 302 and the handle portion 304. The bend portion 312further has a radius of curvature 316 that extends from an axis D-D thatis co-planar with the handle portion 304 to the distal portion 302. In apreferred embodiment, the radius of curvature 316 ranges from about 10mm to about 50 mm.

In a preferred embodiment, the retractor 300 has a length 318 thatextends between the proximal end 308 and the wound contact portion 310.In a preferred embodiment, the length 318 ranges from about 200 mm toabout 300 mm. Residing between the handle portion 304 and the distal endportion 302 is a shaft 320. The shaft 320 generally has a curved crosssectional profile perpendicular to its length, and more preferably, around cross-sectional profile (FIG. 10A). In a preferred embodiment, athickness 342 of the shaft 320 is of a diameter that ranges from about 5mm to about 10 mm.

Similarly to retractors 100 and 200 as previously discussed, the handleportion 304 of retractor 300 resides at the proximal end 308. Likeretractors 100 and 200, the handle portion 308 has a generallyrectangular cross-section with a generally planar top 322 and bottomsurface 324. Alternatively the handle portion 304 may be constructedwith a round or oval cross-section. An alternate handle 306 design isshown in FIGS. 10B and 11A. As illustrated, these alternative handleportion embodiments generally have a handle portion thickness 326 thatis greater than shown in FIGS. 10 and 12. Furthermore, the alternativehandle portion 306 embodiment features a generally frustro-conicalhandle nose 330. Either handle portion embodiment 304 or 306 may have ahandle thickness 326 that can be larger or smaller than the thickness ofthe shaft 320. An opening 328 may extend through the handle portion 304from the top surface 322 through the bottom surface 324. The handleportion 304,306 preferably has a thickness 326 ranging from about 3 mmto about 15 mm. Furthermore, a height 340 extends between the distal end302 of the retractor 300 and the bottom surface 324 of the handleportion 304. In a preferred embodiment, the height 340 ranges from about100 mm to about 200 mm.

The distal portion 302 of retractor 300 preferably has a rectangularcross-sectional profile. However, the distal portion 302 may have acurved or round cross-sectional profile. In a preferred embodiment, thedistal portion has a generally planar surface 328 that extends from thewound contact portion 310 to a distal end 332 of the distal portion 302.Preferably, the distal surface 328 has a width 334 that ranges fromabout 5 mm to about 20 mm. It is also preferred that the distal portion302 may have a thickness 338 that ranges from about imm to about 5 mm.

In the embodiment illustrated in FIGS. 10 and 11, the width 334 of thedistal portion 302 gradually narrows to a point at the end 332 of thedistal portion 302. This point as illustrated in FIGS. 10 and 11,generally curls upwardly and outwardly from the planar surface 328.However, it is contemplated that this point 332 may also curl downwardlyand way from the planar surface 328.

Alternatively, as illustrated in FIGS. 10B and 11A, a prong 336 extendsfrom an edge 338 of the distal portion 302 of the retractor 300. In thisalternative embodiment, the width of the prong 336 is substantially andabruptly smaller than the width of the edge 338 of the distal portion302. The end of the prong 336, i.e., the end 332 of the distal portion302, may curve upwardly or downwardly away from the plane of the distalportion surface 328.

FIGS. 13, 13A, 14 and 15 illustrate an embodiment of a retractor 400generally referred to as a “femoral neck retractor”. The retractor 400comprises a handle portion 402, a bend portion 404, a wound contactportion 406, and a distal portion 408.

As illustrated, a shaft 410 extends therebetween the distal end portion408 and the handle portion 402. In a preferred embodiment, the shaft 410generally has a curved cross-sectional profile perpendicular to itslength, and more preferably, a round cross-sectional profile (FIG. 13A).The shaft 410 preferably has a thickness 412 with a diameter that rangesfrom about 2 mm to about 20 mm. A length 414 extends from a proximal end434 to the end of the distal portion 408 of the retractor 400. In apreferred embodiment, the length 414 ranges from about 200 mm to about400 mm.

Similarly to the retractors 100, 200 and 300 previously discussed, thehandle portion 402 of retractor 400 resides at the proximal end 434 ofthe retractor 400. Like retractors 100, 200 and 300, the handle portion402 generally embodies a rectangular cross-sectional profile with agenerally planar top 436 and bottom surface 438. Alternatively, thehandle portion 402 may be constructed with a round or ovalcross-section. The handle thickness 440 may be larger or smaller thanthe thickness of the shaft 410. An opening may extend through the handleportion 402 from the top surface 436 through the bottom surface 438. Thehandle portion 402 preferably has a thickness 440 ranging from about 3mm to about 15 mm. Furthermore, a height 432 extends between the distalend portion 408 of the retractor 400 and the bottom surface 438 of thehandle portion 402. In a preferred embodiment, the height 432 rangesfrom about 100 mm to about 200 mm.

In an embodiment illustrated in FIGS. 13, 14 and 15, the distal endportion 408 comprises a claw portion 416. More preferably, the clawportion 416 comprises at least one prong 418. These prongs 418 extenddistally from a surface 420 of the claw 416. An inlet 422 residingbetween the two prongs 418 provides a space that separates the prongs418. A claw radius of curvature 424 defines the opening of the inlet 422between the prongs 418. In a preferred embodiment, the radius ofcurvature 424 ranges from about 5 mm to about 25 mm.

It is further preferred that the claw portion 416 is inclined about abottom claw point 426. An incline angle 442 is defined as the anglebetween a horizontal axis E-E that intersects and extends parallel tothe bottom point 426 and imaginary line F-F that is tangent of a bottomsurface 444 of the claw 416. In a preferred embodiment, the claw 416 hasan incline angle 442 ranging from about 5° to about 25°.

It is additionally preferred that the claw surface 420 extends from aninlet apex 428 to a portion 430 between the proximal end of the clawportion 416 and the distal end of the shaft 410. Furthermore, the curvedsurface 420 of the claw 416 is preferably depressed inwards towards thebody of the claw 416, thereby creating an inclined or “wedge like”surface 420 that resides between the end of the prongs 418 and aproximal end of the distal portion 408. This inclined or “wedge like”surface 420 of the claw 416 assists and provides additional engagementof the femoral neck retractor 400. The retractor 400 further has a shaftthickness 412 with a diameter ranging from about 5 mm to about 10 mm.

FIGS. 16, 16A, 17 and 18 illustrate embodiments of a retractor 500generally referred to as a “double ended retractor”. The retractor 500comprises a handle portion 502, a first bend portion 504, a second bendportion 506, a first wound contact portion 508, a second wound contactportion 510, a first distal end portion 512, and a second distal endportion 514. A surgeon can therefore use one or both of the first andsecond distal end portions 512, 514 during an orthopedic surgicalprocedure.

As illustrated, the handle portion 502 is located between the first andsecond distal end portions 512, 514. A shaft 516 extends from a leftside 518 and right side 520 of the handle portion 502. The shaft 516connects the handle portion 502 to the respective distal end portions512, 514. In a preferred embodiment, the shaft 516 generally has acurved cross-sectional profile perpendicular to its length, and morepreferably, a round cross-sectional profile (FIG. 16A). The shaft 516preferably has a thickness 522 with a diameter that ranges from about 5mm to about 10 mm. Furthermore, the overall length 528 of retractor 500extending from the first bend portion 504 to the second bend portion506, preferably ranges from about 200 mm to about 400 mm.

Residing between the handle portion 502 and the first distal end portion512 is the first bend portion 504. The first wound contact portion 508resides therebetween the first distal end portion 512 and the first bendportion 504.

The first bend portion 504 is defined by a first bend angle 524 thatgenerally measures about 90°. The first bend angle 524 is measuredbetween horizontal axis G-G, co-axial to the handle portion 502, andperpendicular axis H-H. Although a 90° first bend angle 524 ispreferred, the angle 524 may range from about 70° to about 130°.

Additionally, residing between the handle portion 502 and the seconddistal end portion 514 is a second bend portion 506. A second woundcontact portion 510 resides therebetween the second distal end portion514 and the second bend portion 506.

The second bend portion 506 is defined by a second bend angle 526 thatgenerally measures about 90°. The second bend angle 526 is measuredbetween horizontal axis G-G, co-axial to the handle portion 502, andperpendicular axis I-I. Although a 90° second bend angle 526 ispreferred, the angle 526 may range from about 70° to about 130°.Furthermore, the first and second angles 524, 526 may or may not beequal.

The first distal end portion 512 extends from the distal end of thefirst wound portion 508 to a distal end 530 of the first distal endportion 512. The first distal end portion 512 preferably has a generallyrectangular cross-section. However, the distal portion 512 may have acurved or round cross-sectional profile. A first claw portion 532preferably comprising at least one prong 534 extends to the end 530 ofthe first distal end portion 512. The claw portion may or may not bepositioned such that it curves inwardly and outwardly from perpendicularaxis H-H as shown in FIG. 17.

Additionally, it is preferred that the first distal end portion 512comprises a planar first distal end portion surface 536. Although thissurface 536 may not necessarily be constructed such that it is planar.Instead, it may be designed with a curved surface. This surface 536enables the user to place the end of the retractor 530 between musclesand/or tissue with increased precision and ease. In a preferredembodiment a length 538 of the first distal end portion surface 538 isfrom about 20 mm to about 60 mm. Furthermore, the first distal endportion 512 has a thickness 540 that ranges from about 2 mm to about 10mm and a first distal end width 542 that ranges from about 5 mm to about30 mm. A first distal end portion height 544 preferably extends from thedistal end 530 of the first distal end portion 512 to the first bendportion 504. In a preferred embodiment, the first distal end portionheight 544 ranges from about 50 mm to about 150 mm.

The second distal end portion 514 extends from the distal end of thesecond wound portion 510 to a distal end 546 of the second distal endportion 514. The second distal end portion 514 preferably has agenerally rectangular cross-section. However, the distal portion 514 mayhave a curved or round cross-sectional profile. A second claw portion548 preferably comprising at least one prong 534 extends to the end 546of the second distal end portion 514. The second claw portion 548 may ormay not be positioned such that it curves inwardly from perpendicularaxis I-I as shown in FIG. 17. Alternatively, the second claw portion 548may be positioned outwardly from perpendicular axis I-I.

It is further preferred that the second distal end portion 514 comprisea planar second distal end portion surface 550. However, this surface550 may not necessarily be constructed such that it is planar. Instead,it may be designed with a curved surface. This surface 550 enables theuser to place the end of the retractor 546 between muscles and/or tissuewith increased precision and ease.

In a preferred embodiment, the length 552 of the second distal endportion surface 550 ranges from about 10 mm to about 30 mm. Furthermore,the second distal end portion 514 has a thickness 554 from about 2 mm toabout 10 mm and a second claw width 556 that preferably ranges fromabout 2 mm to about 20 mm. A second distal end portion height 558extends from the distal end 546 of the second distal end portion 514 tothe second bend portion 506. In a preferred embodiment, the seconddistal end portion height 558 ranges from about 20 mm to about 80 mm.

Advantageously, the curved cross-section of the retractors 100, 200,300, 400 and 500 inhibit necrosis of the tissue of the incision thatcontacts the wound contact portions 106, 210, 310, 406, 508, 510 therebyallowing a surgeon to perform the surgical procedure withouttraumatizing the tissue. This helps reduce the length of the surgicalprocedure and retain the tissue of the tissue generally intact.Additionally, the curved cross-sectional profile and reducedcross-sectional dimensions of the retractor 500 allows the retractor ormultiple retractors to be placed in a variety of positions within theincision while allowing the insertion of other surgical tools (e.g.reamer) through the access space defined through the incision.

Additionally, unlike conventional retractors, which have a generallyflat and rectangular cross-sectional profile, the curved cross-sectionalprofile and reduced cross-sectional dimensions of the retractors 100,200, 300, 400 and 500 helps prevent contact with the reamer when thelatter is inserted through the access space defined by the incision andoperated to ream the acetabulum. Though conventional retractors withsmaller widths have been tried, the reduction in width generallyresulted in a decreased retractor strength that can lead to damage ofthe retractor. In contrast, the retractors 100, 200, 300, 400 and 500described above inhibit such jamming with the reamer while retainingsufficient strength to inhibit breaking of the retractors 100, 200, 300,400 and 500 during the surgical procedure.

In one embodiment, one or more of at least one of the retractors 100,200, 300, 400 and 500 of FIGS. 4-18 can be provided as part of a kit.However, in another embodiment, fewer or more retractors can be providedas part of the kit, each retractor having a different shape, with eachretractor 100, 200, 300, 400 and 500 having a generally roundcross-sectional profile or generally oval cross-sectional profile at thelocation where the retractor engages the tissue defined by the incision.The retractors 100, 200, 300, 400 and 500 can be made of any suitableknown material for use in surgical procedures. Preferred examples ofsuch materials include, but are not limited to, stainless steel, MP35N,aluminum, as well as polymeric and ceramic materials.

Of course, the forgoing description is that of certain features, aspectsand advantages of the present invention, to which various changes andmodifications can be made without departing from the spirit and scope ofthe present invention. Moreover, the retractors need not feature all ofthe objects, advantages, features and aspects discussed above. Thus, forexample, those of skill in the art will recognize that the invention canbe embodied or carried out in a manner that achieves or optimizes oneadvantage or a group of advantages as taught herein without necessarilyachieving other objects or advantages as may be taught or suggestedherein. In addition, while a number of variations of the invention havebeen shown and described in detail, other modifications and methods ofuse, which are within the scope of this invention, will be readilyapparent to those of skill in the art based upon this disclosure. It iscontemplated that various combinations or sub-combinations of thesespecific features and aspects of embodiments may be made and still fallwithin the scope of the invention. Accordingly, it should be understoodthat various features and aspects of embodiments may be made and stillfall within the scope of the invention. Accordingly, it should beunderstood that various features and aspects of the disclosedembodiments can be combined with or substituted for one another in orderto form varying modes of the discussed retractor system and kit.Additionally, one of ordinary skill in the art will recognize that theretractor embodiments described herein are not limited for use in hipreplacement surgeries, or for use in orthopedic surgical procedures, butcan be used in other surgical procedures (e.g., abdominal or spinal).

1. A retractor for use in surgery, the retractor comprising: a) a handleconfigured to be held by a user; b) a wound contact plate comprising atleast a proximal wound contact plate portion having spaced apart frontand back proximal planar plate faces providing a plate thicknessextending to first and second plate edges; and c) a solid intermediateshaft comprising a shaft length extending from a proximal shaft portionto a distal shaft portion, wherein the proximal shaft portion isconnected to the handle along a first axis and the distal shaft portionis rigidly connected to the proximal wound contact plate portion along asecond axis, d) wherein an intermediate bend portion of the shaftextends from the first axis to the second axis through a bend angleranging from 70° to 130°, e) wherein a first plane is aligned along thesecond axis and at least the proximal wound contact plate portionrigidly connected to the distal shaft portion, the first plane bisectingthe proximal wound contact plate portion between the front and backplanar proximal plate faces and extending to the right and left plateedges, and f) wherein at least the bend portion of the shaft and thedistal shaft portion have a round cross-section perpendicular to theshaft length with a diameter of the round cross-section being less thana maximum width of the wound contact plate portion measured from theright plate edge to the left plate edge.
 2. (canceled)
 3. The retractorof claim 1, wherein the round cross-section of at least the bend portionof the shaft and the distal shaft portion has a diameter that rangesfrom 5 mm to 10 mm.
 4. The retractor of claim 1, wherein the handle hasan opening extending through a handle thickness.
 5. The retractor ofclaim 1, wherein the handle comprises a planar top surface.
 6. Theretractor of claim 1, wherein the wound contact plate comprises a distalprong extending from the proximal wound contact plate portion.
 7. Theretractor of claim 6, wherein the distal prong of the wound contactplate extends either away from the second axis of the distal shaftportion or towards the first axis of the proximal shaft portion.
 8. Theretractor of claim 6 wherein the distal prong of the wound contact plateextends along a second plane bisecting the distal prong between distalfront and back prong faces.
 9. The retractor of claim 8, wherein thesecond plane bisecting the distal prong extends either away from thesecond axis of the distal shaft portion or towards the first axis of theproximal shaft portion.
 10. The retractor of claim 1, wherein the bendportion of the shaft has a radius of curvature ranging from 2 mm to 50mm.
 11. (canceled)
 12. (canceled)
 13. The retractor of claim 1, whereinthe retractor is composed of a metal, a polymer or a ceramic material.14-22. (canceled)
 23. The retractor of claim 1 wherein the shaft has around cross-section extending from the proximal shaft portion connectedto the handle to the distal shaft portion connected to the proximalwound contact plate portion.
 24. The retractor of claim 1 wherein thesecond axis bisects the proximal wound contact plate portion between thefirst and second planar plate edges.
 25. A retractor for use in surgery,the retractor comprising: a) a handle configured to be held by a user;b) a wound contact plate comprising a proximal wound contact plateportion and a distal prong extending from the proximal wound contactplate portion, wherein the proximal wound contact plate portion hasspaced apart front and back planar proximal plate faces providing aplate thickness extending to first and second plate edges; and c) asolid intermediate shaft comprising a shaft length-extending from aproximal shaft portion to a distal shaft portion, wherein the proximalshaft portion is connected to the handle along a first axis and thedistal shaft portion is rigidly connected to the proximal wound contactplate portion along a second axis, d) wherein an intermediate bendportion of the shaft extends from the first axis to the second axisthrough a bend angle ranging from 70° to 130°, e) wherein a first planeis aligned along the second axis and at least the proximal wound contactplate portion rigidly connected to the distal shaft portion, the firstplane bisecting the proximal wound contact plate portion between thefront and back planar proximal plate faces and extending to the rightand left plate edges, and f) wherein the distal prong of the woundcontact plate extends either away from the second axis of the distalshaft portion or towards the first axis of the proximal shaft portion,and g) wherein the shaft has a round cross-section extending from theproximal shaft portion connected to the handle to the distal shaftportion connected to the proximal wound contact plate portion with adiameter of the round cross-section being less than a maximum width ofthe wound contact plate portion measured from the right plate edge tothe left plate edge.
 26. The retractor of claim 25 wherein the roundcross-section of the shaft has a diameter that ranges from 5 mm to 10mm.
 27. The retractor of claim 25 wherein the second axis bisects theproximal wound contact plate portion between the first and second planarplate edges.
 28. The retractor of claim 25 wherein the bend portion ofthe shaft has a radius of curvature ranging from 2 mm to 50 mm.
 29. Aretractor for use in surgery, the retractor comprising: a) a handleconfigured to be held by a user; b) a wound contact plate comprising aproximal wound contact plate portion and a distal prong extending fromthe proximal wound contact plate portion, wherein the proximal woundcontact plate portion has spaced apart front and back planar proximalplate faces providing a plate thickness extending to first and secondplate edges; and c) a solid intermediate shaft comprising a shaftlength-extending from a proximal shaft portion to a distal shaftportion, wherein the proximal shaft portion is connected to the handlealong a first axis and the distal shaft portion is rigidly connected tothe proximal wound contact plate portion along a second axis, d) whereinan intermediate bend portion of the shaft extends from the first axis tothe second axis through a bend angle ranging from 70° to 130°, e)wherein a first plane is aligned along the second axis and at least theproximal wound contact plate portion rigidly connected to the distalshaft portion, the first plane bisecting the proximal wound contactplate portion between the front and back planar proximal plate faces andextending to the right and left plate edges, and f) wherein the distalprong of the wound contact plate extends along a second plane bisectingthe distal prong between distal front and back prong faces and whereinthe second plane extends either away from the second axis of the distalshaft portion or towards the first axis of the proximal shaft portion,and g) wherein the shaft has a round cross-section extending from theproximal shaft portion connected to the handle to the distal shaftportion connected to the proximal wound contact plate portion with adiameter of the round cross-section being less than a maximum width ofthe wound contact plate portion measured from the right plate edge tothe left plate edge.
 30. The retractor of claim 29 wherein the roundcross-section of the shaft has a diameter that ranges from 5 mm to 10mm.
 31. The retractor of claim 29 wherein the second axis bisects theproximal wound contact plate portion between the first and second planarplate edges.
 32. The retractor of claim 29 wherein the bend portion ofthe shaft has a radius of curvature ranging from 2 mm to 50 mm.